Experience of application of nadroparin calcium in a patient with melanoma after organ-preserving surgery with musculocutaneous flap-plasty on the vascular pedicle of the defect

Abstract

Patients with malignant diseases belong to the high risk group for thrombosis and pulmonary embolism development [1-3]. Any reconstructive plastic surgery in such patients has potential complications that can reduce all efforts to zero [4-6]. Antithrombotic therapy is a complex problem of modern oncology [7-9]. For a long time, all patients with subungual melanoma underwent only one type of operation – amputation [10, 11]. In order to avoid mutilating surgery and preserve the maximum functionality of the limb, we have developed and proposed an organ-preserving operation with an optimal antithrombotic approach in the postoperative period. In the present scientificpractical article the clinical observation of the patient after removal of subungual melanoma (SM) with musculocutaneous flap-plasty on the vascular pedicle of the defect with the developed optimal approach of thrombosis and thromboembolism prophylaxis with the use of fraxyparine is presented. In the case of sonodoplerographic imaging of vessels of the I finger of the left hand, the passage of a. digitalis palmaris proprius is marked. A dissection of the vascular pedicle containing a. digitalis palmaris proprius, a fragment of m. interosseus dorsalis I, subcutaneous adipose tissue with subcutaneous venous system branches along the side surface of the I finger of the left hand to the projection of the phalangeal joint was performed. Mobilized musculocutaneous flap was placed on the defect and was fixed to the wound edges. The control of the vascular pedicle permeability by means of color and energy mapping of the blood flow was performed. The control of the flap was carried out on the 7th, 15th, 21st day [12, 13]. The flap engraftment is 100 %. The patient could already write with a pen and cut paper with scissors on the 7-10th day. She is currently in full clinical remission and has returned to her working life. Without proper thrombosis prophylaxis, it would be impossible to maintain the functionality of the vascular stem and, given the nature of malignant neoplasms, to reduce the risk of thromboembolism [14-17]. Presented experience of antithrombotic therapy opens new possibilities of surgical treatment with reconstructive-plastic component in patients with malignant neoplasms.